| Field Name |
Field Value |
| Healthcare Common Procedure Coding System Code |
B4157 |
| HCPCS Sequence Number |
0010 |
| HCPCS Record Identification Code |
3 - First line of procedure record also contains detail information in positions 92-275 |
| HCPCS Long Description |
Enteral formula, nutritionally complete, for special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
| HCPCS Short Description |
Ef special metabolic inherit |
| HCPCS Pricing Indicator Code 1 |
39 - Parenteral and Enteral Nutrition |
| HCPCS Multiple Pricing Indicator Code |
A - Not applicable as HCPCS priced under one methodology |
| HCPCS Coverage Issues Manual Reference Section Number 1 |
65-10 |
| HCPCS Coverage Code |
D - Special coverage instructions apply |
| HCPCS Berenson-Eggers Type Of Service Code |
O1C - Enteral and parenteral |
| HCPCS Type Of Service Code 1 |
E - Enteral/parenteral nutrients/supplies (eff 04/95) |
| HCPCS Anesthesia Base Unit Quantity |
0 |
| HCPCS Code Added Date |
1/1/2005 |
| HCPCS Action Effective Date |
1/1/2005 |
| HCPCS Action Code |
N - No maintenance for this code |